Aligning Nutrition, Calories and Enjoyment
Last week, I presented a talk to employees of a large food company, when (not surprisingly) the talk soon enough centred on the issue of “healthy eating” as a way to better manage your weight. This prompted me to point out that healthy eating (at least in the conventional sense) and weight management are actually two different issues – related perhaps, but different! We only need to remind ourselves of Mark Haub, a professor of human nutrition at Kansas State University, who for 10 weeks sustained himself on a “convenience store diet” consisting largely of Hostess and Little Debbie snacks, Dorito chips, sugary cereals and Oreos, thereby losing 27 pounds and reducing his BMI from 28.8 to 24.9 – all of this, with no exercise (accompanied by a 40% reduction in trygylcerides and a 20% increase in HDL cholesterol – go figure!). Haub conducted this “experiment” to illustrate one simple point: when you eat fewer calories than you burn, you lose weight – even on the “unhealthiest” diet imaginable (he limited himself to 1800 Cal, well below his estimated requirement of about 2400 Cal). Conversely, although, I am not sure that anyone has done this, I am completely certain that you could eat the healthiest possible diet (orthorexic organic vegan if you chose) and yet gain weight by consuming more calories than you need. Thus, the “healthiness” of your diet and the “caloric content” of your diet actually have little to do with each other. “Healthiness” is a matter of nutrients – ensuring that your diet delivers the appropriate amount of macro and micronutrients to your body to ensure its “nutritional balance”. However, whether or not you gain or lose weight on that nutritionally balanced “healthy” diet, ultimately depends on its caloric content. In other words, it does not matter how healthy or unhealthy your diet is – if you don’t cut calories, your weight stays the same. (as 85% of weight management is about calories “in” – let’s not worry about physical activity in this discussion) Ideally, a “healthy diet” would ensure both “nutritional” and “caloric” balance – i.e. give you all the nutrients you need to be healthy AND exactly the number of calories you need to maintain your weight. There is, however, a third characteristic of a diet that plays into this discussion – the feeling of enjoyment (pleasure, happiness, excitement, satisfaction, comfort). Enjoyment is elicited by… Read More »
Weekend Roundup, January 18, 2013
As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Coca Cola Refreshingly Embraces Obesity Applauding Baby Steps What Works For You May Not Work For Me Why Are Some People Successful At Maintaining Weight Loss? Will Turning Off Your Bedroom Lights Make You Lighter? Have a great Sunday! (or what is left of it) AMS Edmonton, AB
Is Not Medicalizing Obesity Discrimination?
Here is a brief excerpt from a recent talk, in which I discuss why I believe that not medicalizing obesity is a form of discrimination: Appreciate your comments. AMS Edmonton, AB
Will Turning Off Your Bedroom Lights Make You Lighter?
Regular readers are well aware of the mounting evidence on the importance of sleep deprivation as a driver of obesity. Now, a paper by Kenji Obayashi from the Nara Medical University (Japan), published in the Journal of Clinical Endocrinology and Metabolism, takes this issue one step further. The researchers looked at the relationship between intensity of light in the bedroom, BMI and other variables in 528 elderly individuals. Compared with the individuals with no to very low night-time light exposure (<3 lux – note: a full moon night is about 1 lux, twilight is about 3 lux), those with higher exposure (average ≥3) were significantly heavier (by about 4 lbs), had about one unit higher BMI, and about two cms larger waistlines. Individuals with greater light exposure, were almost twice as likely to meet BMI criteria for obesity. These associations were independent of numerous potential confounders, including demographic and socioeconomic parameters. Obviously, the meaning of these data are far from conclusive and it would be premature to draw any inferences regarding causality. It may however be plausible to hypothesize that even minimal amounts of night-time light exposure can affect quality of sleep, thereby in turn, affecting metabolism (in ways in which we now know sleep-deprivation to do). It would certainly be of interest to see how such findings can be reproduced in a more experimental setting – I would not be surprised if these findings can be confirmed and further highlight the importance of ensuring not only adequate duration but also quality of sleep. AMS Edmonton, AB Obayashi K, Saeki K, Iwamoto J, Okamoto N, Tomioka K, Nezu S, Ikada Y, & Kurumatani N (2013). Exposure to Light at Night, Nocturnal Urinary Melatonin Excretion, and Obesity/Dyslipidemia in the Elderly: A Cross-Sectional Analysis of the HEIJO-KYO Study. The Journal of clinical endocrinology and metabolism, 98 (1), 337-44 PMID: 23118419 .
Applauding Baby Steps
Many years ago, I had a patient (let’s call him Tony). Tony was 48 years old, had a BMI of 43, elevated blood pressure (uncontrolled), reflux disease (Tums PRN), and occasional gout attacks (Tylenol 3s PRN). Tony fitted every imaginable obesity stereotype – his diet consisted essentially of donuts and pizza (with a few chicken wings and fries thrown in for good measure). He was a self-proclaimed “meat and potato” guy (and proud of it). His daily consumption of beer was essentially unchanged since college. Tony’s activity levels consisted largely of moving from his bed to his car to his desk to his car to his couch to his bed. HIs idea of exercise was watching Hockey Night in Canada. When I first saw him, it was immediately apparent that he had no interest in seeing me (or anyone else in the clinic). He was here because his wife threatened divorce unless he lost some weight, his daughter threatened to no longer let him see his grandkids till he changed his attitude and lifestyle, his boss had passed him up for promotion twice because of his size. Despite this Tony was in complete denial. He was not “obese” (just husky!), hypertension was something invented by the pharmaceutical industry so they can sell drugs, his heartburn was because he had a hernia, his painful toe was because of having stubbed it years ago (the doctors never fixed it!). He felt he was in the best of health for a man in his age and thought this was all a waste of time. As you may imagine, Tony was not very open to any form of lifestyle counselling. Nevertheless, the rest of the team and I saw him several times over the next six months despite him regularly missing appointments and showing virtually no “progress”. Finally, after six months of little progress, the team had come to the rather strong opinion that it was time to discharge him from the clinic. Thus, I was tasked with ‘firing’ him at his next visit. When Tony came in, he was in a bad mood. His toe had flared up. The pills I had prescribed for his blood pressure were affecting his sexual function. His boss had finally threatened to fire him. I quietly listened to his complaints and then told him that the team had decided that we felt that we were not helping… Read More »
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